Intravenous (IV) Therapy is defined as the insertion of a needle into a vein, based on the physician's written prescription. The needle is attached to a sterile tubing and a fluid container to provide medication and fluids

1. HAZARDS OF I.V
THERAPY
MOODA PINKI

2. DEFINITION OF IV THERAPY
Intravenous (IV) Therapy is defined as the insertion of a needle into a vein,
based on the physician's written prescription. The needle is attached to a sterile
tubing and a fluid container to provide medication and fluids.

3. REASONS
Hazards may be because of the following,
1. Inadequacy in the manufacturing of products.
2. Inadequacy during transport, storage, and handling.
3. Inadequacy during administration.

4. SEPSIS
◦ It results from microorganisms contaminating the product or delivery
system before or during use or from microorganism precipitation on the
patient skin.
◦ e.g. —S. aureus.
◦ Sepsis may be localized (abscess) or systemic(septicemia).
◦ In-line bacterial filters remove the contamination.
◦ However, they are costly affect flow rate, and may sometimes get
blocked.
◦ Common contamination are S.epidermidis , candidaspp. , E.coli,
Enterobacteria, proteus klebsiella, Pseudomonas.

5. TOXEMIA
◦ It is due to biological toxin contaminating theproduct.
◦ Endotoxins of gram -ve bacteria ca use,
I. Rise in body temp.
II. Shivering,
III. Vasoconstriction
IV. Increase in B.P
V. Respiratory depression
VI. Pain in a joint. & back, headache, nausea etc.

6. THROMBOSIS
◦ It occurs with i.v. infusion and may cause following complications,
I. Emboli formed may reach the lungs causing pulmonary thrombosis
II. Secondary infection may cause septicemia.
◦ Thrombosis of the artery is more serious than that of vein as it may cause
gangrene of concerned organ.

7. PLEBITIS
It occurs with i.v. infusion. It may or may not be associated with infection or may
or may not result in thrombosis.

8. BLEEDING
It occurs if the blood vessel is damaged by a needle or if the patient has
platelet deficiency called hemophilia.

9. PARTICULATE MATTER HAZARD
◦ Se Particles >7 um are more dangerous than smaller ones.
◦ Particulate matter may cause occlusion of capillaries and blood vessels
resulting in ischemia and necrosis of tissue.
◦ Thrombosis and embolism, phlebitis, thrombophlebitis, allergenic reaction,
neoplastic response, pain, and inflammation.

10. HAZARDS DUE TO PHYSICOCHEMICAL
PROPERTIES OF FORMULATION
◦ pH and osmotic pressure of formulation may have damaging effects on tissue.

11. HYPERSENSITIVITY
◦ Hypersensitivity reaction because of drug itself, these may be immediate or
delayed type.

12. OVERDOSE & AIR EMBOLI
◦ Overdose of drug and overload of fluid from i.v. administration.
◦ Emboli occur with i.v. infusion without an alarm system is used.
◦ As little as 10 ml of air may be fatal.
I. Care should be taken to remove all air bubbles from the syringe or i.v. line prior to
starting the infusion.

13. INFILTRATION AND EXTRAVASATION
◦ Infiltration is an unintentional infusion of a drug into a tissue.
◦ Extravasation is leakage of a drug from a vesselinto surrounding tissue.
◦ Hypertonic Dextrose KCl solution and extreme of pH may cause considerable
pain if extravasation occurs, leading to infection, phlebitis, and thrombosis.

14. HAZARDS DUE TO INCOMPATIBILITY
◦ Intravenous admixture incompatibility could be fatal because of the formation
of toxic substance.

15. Extravasation
◦ Extravasation, the leaking of vesicant drugs into surrounding tissue, can cause
severe local tissue damage.
◦ 0.5% to 6% of all patients receiving chemotherapy.
◦ Cancer patients at risk?
◦ Multiple infusions
◦ Malnourishment
◦ Side effects of Chemo and Radiotherapy

16. PARENTRAL ADMIXTUREINCOMPATIBILITY
◦ Admixture: when two or more parenteral combines, the resulting mixture is
admixture.
◦ Additive: when SVP is added to LVP, the added SVP is called additive.

17. PARENTRAL ADMIXTURE
INCOMPATIBILITY
Parenteral admixture is used because,
◦ Physician prescribes administration of several drug combining the drug and
administering them several time and resulting in inconvenience.
◦ The no. of pricking to the patient is reduced.
◦ PARENTRAL INCOMPATIBILITY
◦ There are physical, chemical, or therapeutic problems that arise when
parenteral drugs are combined and admin. by injection.

18. PARENTRAL INCOMPATIBILITY
Problems of parenteral admixture incompatibility is of concern because,
1. There is increased use of parenteral in therapeutics.
2. Several parenteral formulations are available in the market.
3. There is the increased use of LVP as the vehicle of SVP.
4. Formulations are available in different drugs.
5. Order of mixture of parenteral at the time of administration may be
important.
6. Delayed incompatibility may possible

19. FOLLOWING HAZARDS
Parenteral admixture incompatibility may lead to the following hazards.
◦ The patient may not receive the full therapeutic effect of the mixture.
◦ Toxic decomposition.
◦ There may be irritation of the vein or occlusion of vessels.

20. TYPES OF INCOMPATIBILITY
1. Physical incompatibility
2. Chemical incompatibility
3. Therapeutic incompatibility
Two formulations are combined together to show antagonistic or synergistic
action.

21. PHYSICAL INCOMPATIBILITY
This may result in to change in colour precipitation formation or evolution of
gas.e.g.
1. Phenytoin sodium inj + LVP of acidic pH(dextrose) - In this reaction phenytoin
get precipitates.
2. Diazepaminj+ LVP - In this precipitation of diazepam is observed.
3. Sodium phenobarbitone + LVP of acidic pH(dextrose) - in this reaction
phenobarbitone get precipitate.